Identifying Active Aging Policy Objectives in Italian Regions

Abstract

Background: In light of the main challenges recognized as being linked to the operationalization of the active aging concept at the policy level, the present study aimed to understand whether and to what extent Italian regional governments plan to deal with these challenges, i.e., implementing inter-sectoral and multilevel cooperation in a mainstreaming aging perspective; creating participatory processes by involving stakeholders in policymaking; and implementing the multidimensionality of active aging. Methods: Interviews with representatives of all Italian regions were conducted, and contributions by regional civil society stakeholders were collected. A framework analysis was conducted to identify and categorize policy objectives. Results: Policy plans to deal with the issues under study are in place in all Italian regions; however, differences across regions depend on two main factors: the presence of a relevant regulatory framework and its degree of implementation. Conclusion: policy recommendations for improving the current state concerned awareness-raising campaigns to strengthen the dialogue between regional governments and civil society stakeholders and the need for provisions issued at the national level to advance and harmonize regional policy tools in this area.

1. Introduction

In recent decades, dealing with population aging has become a priority for policymakers, resulting in the emergence of new social and policy needs (UNECE and European Commission 2019). The active aging (AA) concept has been recognized as a useful tool in order to address the challenges posed by demographic aging (Rojo-Pérez et al. 2021; Foster and Walker 2015). AA is defined as “the process of optimizing opportunities for health, participation, and security in order to enhance quality of life as people age” (WHO 2002, p. 12). To this end, AA invokes a paradigm shift from the traditional vision of older people as mostly in need of care towards a perspective that considers older people as active and with resources to express (Walker 2002). It suggests a holistic approach to managing social problems related to old age, with related benefits for both older individuals—in terms of physical and mental health, due to formal or informal activation of older individuals in social or personal fields (Eckstrom et al. 2020; Foster and Walker 2021; Menichetti et al. 2016)—and society as a whole. For instance, at the individual level, it has been observed that activation of older people in the field of volunteering is positively related to health benefits in terms of physical health, including functional limitations, better self-perceived health, and reduced risk of depression (e.g., (Huang 2019). Activation in terms of lifelong learning has been related to an improvement in self-perceived health and well-being (Narushima et al. 2018; Formosa 2019). Therefore, active aging is considered an effective prevention tool (Foster and Walker 2021; Boudiny 2013), among others, aimed at reducing risk factors to promote healthy aging as an outcome. As for the benefits for society as a whole, active aging supports the sustainability of the welfare systems through the reduction of public expenditure for health and social care interventions while also enhancing the social and productive contribution derived from activities undertaken by older people (Hemerijck 2023; Walker and Maltby 2012).

In Europe, the AA concept is being mainly implemented through the Regional Implementation Strategy (RIS) of the Madrid International Plan of Action on Aging (MIPAA) of the United Nations (Kwitsinskaia 2023; UNECE 2002) and the related 10 commitments1. The MIPAA, while being considered as a soft law tool, represents the main international policy framework to stimulate policymaking at the national level on this topic. In addition to the Global Strategy and Action Plan on Aging and Health (Rudnicka et al. 2020; WHO 2017), the RIS aimed at developing renewed action in this field, and the Sustainable Development Goals (SDGs)2, further developed under the Agenda 2030 for Sustainable Development (UN 2015), were aligned with them (Schmid 2024).

The full implementation of the MIPAA/RIS strategy, from an AA perspective, depends on the creation of adequate methods and tools to identify policy measures and objectives, capable of guaranteeing widespread diffusion and effectiveness of the AA concept at both the national and the regional level (Leichsenring and Sidorenko 2024; Zelenev 2006). Since AA is a comprehensive, not coercive, and inclusive concept, it should be incorporated in national policy strategies based on partnerships between citizens and institutions (Foster and Walker 2015). However, despite such kinds of strategies being advocated by important international bodies (UNECE 2022; WHO 2002), the gerontological literature on AA shows some critical aspects when it comes to shifting from theory to practice by operationalizing the AA concept in Europe. In particular, as explained in the following section, when studying the actual implementation and operationalization of the UN framework, three main criticalities are highlighted in the literature: 1. weak inter-sectoral and multi-level cooperation for the development of AA policies (MIPAA commitment 1); 2. the scarcity of participatory processes for policy making on AA (SDG 17); the difficulty in ensuring the multidimensionality of the AA concept when translated into policies (MIPAA 2, 5, 6, 9; SDGs 4, 8) (Falvo et al. 2017; Foster and Walker 2021; UNECE 2022; Walker 2002; Zaidi et al. 2018).

1.1. Critical Aspects in the Operationalization of AA at the Policy Level

1.1.1. Criticality 1: Weak Inter-Sectoral and Multi-Level Cooperation

In terms of AA policy design and implementation, one of the most salient issues is the lack of clear cooperation between the various policy areas and governance levels across European countries, which is essential for the identification of policy objectives and their successful implementation (Glicksman et al. 2014; Kim et al. 2017; Santinha et al. 2020). It is important to overcome fragmented approaches and the tendency to operate “in silos,” which poses barriers to comprehensively addressing aging-related aspects. Also, multi-level cooperation is crucial to ensure the quality and effectiveness of public policies, considering the heterogeneity and diversity of each territory (UNECE 2022). In this regard, coordination mechanisms and integration of aging issues across all sectors and policy levels (as advocated by MIPAA commitment 1, mainstreaming aging) are not present in most of the existing European national AA policy approaches (Lucantoni et al. 2022; UNECE 2022). In many cases, mainstreaming aging has mostly been featured as an aspiration in international strategies and plans, with no emphasis on systematically ensuring coordination and policy coherence across policy areas and government levels (Zaidi et al. 2018).

Moreover, the multi-level policy approach is often hindered by the lack of involvement of the regional/local level, as in several countries, strategies are developed by specific national governmental bodies, while municipalities are directly responsible for implementing the policy objectives identified by the former (Fernandes et al. 2021).

1.1.2. Criticality 2: Scarcity of Participatory Processes

Multi-actor networks of public and private stakeholders, including older people themselves, may well be the most suitable governance tool to deal with AA issues, which can be successfully addressed by bringing together resources of different organizations, interests, and advocacy groups (Haldane et al. 2019; Lowndes and Skelcher 1998), in line with the SDG n. 17 “Partnerships for the goals”. Involving a broad and balanced spectrum of key actors at different government levels enables the creation of multi-dimensional and resilient solutions (UNECE 2022) by fostering a whole-of-society approach in the definition of policy aims (Del Barrio et al. 2018; OECD 2005). Despite the latter, stakeholders’ involvement in developing AA national strategies and policy objectives is practiced to a very limited extent in most of the European countries (Barland et al. 2016; Fernandes et al. 2021). As a matter of fact, the direct involvement of older people in policymaking, by implementing co-decisional tools for coordination and dialogue between governmental bodies and stakeholders, is an exception rather than the rule (Falanga et al. 2020). In a few countries (e.g., Denmark, Germany, Ireland), stakeholders’ involvement is mainly realized at the local level (e.g., municipalities) through, e.g., Seniors’ Councils or Seniors’ Forums, or similar tools (Falanga et al. 2020). This way, older citizens have the right to influence the creation of policies aimed at them. Since stakeholders’ involvement in policy making on AA is largely neglected, in European countries, policy design and implementation on the subject is mainly realized unilaterally by governing bodies through a top-down approach (Zaidi et al. 2018).

1.1.3. Criticality 3: Difficulty in Ensuring the Multidimensionality of the AA Concept

Even if AA is a broad and multidimensional concept, going far beyond the mere promotion of participation in the labor market, a productivist interpretation prevailed for quite a long time at the policy level, concentrating efforts on raising employment levels in older age groups (Boudiny 2013; Moulaert and Biggs 2013; Van Dyk 2014). The productivist approach tends to promote policies oriented towards utilitarian ends (Minkler and Estes 2020). In terms of AA, this implies the idea that the productive contribution (e.g., work performances) of older people reflects their personal worth (Xu et al. 2020), thus devaluing other possible opportunities for self-development. Labor market and employment issues can also be addressed, from an AA perspective, through age management policies aimed at improving the quality of work settings and work arrangements for aging employees. However, such policies are still not widespread in European countries (European Commission 2024). Although enabling older people to productively contribute to society is an important policy objective, it is also essential that such policies are incorporated into a more inclusive strategy that addresses all positive aspects of older people’s lives (Zaidi and Howse 2017). Despite the progress in aging-related policies over the past 20 years, the development of approaches to comprehensively address all AA dimensions (e.g., volunteering, lifelong learning, cultural activities, etc.) is still in its early stages, both at the European and the national level (UNECE 2022). This underestimates the importance of adequately considering all other policy areas included in the MIPAA/RIS framework, resulting in the foreclosure of promoting equal chances of leading a good life in old age (Pfaller and Schweda 2019). In several European countries, most AA strategies are focused on a limited number of dimensions (e.g., labor market, independent life, and health) (Foster and Walker 2021; WHO 2002; Zaidi et al. 2018), and policy objectives are often identified by central governments, which typically tend to assign importance to domains such as employment and the labor market (Lassen and Moreira 2014).

Although these main policy challenges linked to the operationalization of the AA concept are known, there is a lack of studies examining whether and how policy makers intend to face them (Lucantoni et al. 2022).

1.2. The Italian Case

In light of all the above, in the European context, the Italian case is particularly interesting. On the one hand, Italy has been for many years the country with the highest number of people aged 65+ (24% of the total population) in Europe (Eurostat 2023). On the other hand, due to recent developments in this field at the policy level, in 2016, there were attempts to organically address the issue of AA at the national policy level by developing laws proposals. However, these proposals never reached the voting stage in Parliament (Barbabella et al. 2022). In the following three years, at the national level, the few existing AA policies were developed in a predominantly sectoral way, and mainly in order to increase the participation of older people in the labor market by postponing the retirement age to reduce public spending on pensions (Barbabella et al. 2022). However, compared to the national level, the regional or local level offers a more advanced picture on the topic of AA: 12 out of the 19 Italian regions and the 2 Autonomous Provinces (hereafter regions) have enforced a law for promoting AA at the regional level, in a multidimensional way. In two other regions, effective norms and rules on this topic have been implemented, even in the absence of a specific law on AA (Barbabella et al. 2022).

Although at the regional level, active aging is more considered within the policy agendas, there are large differences across them in terms of resource allocation, dialogue, and coordination between actors, as well as in terms of AA policy development and implementation (Principi et al. 2021). In some regions, the AA paradigm in substitution of the classic and unilateral view of old age, as characterized by disengagement and dependency (Foster and Walker 2015), was hardly recognized. For this reason, in the European context, Italy represents an emblematic case of regional diversity, being characterized by a pronounced lack of economic development of some regions—considered as the most important barrier to national development (Federico et al. 2019; Putnam et al. 1994). Currently, the socio-economic gap between Northern and Southern Italian regions is reflected by several indicators related to population, wealth, and quality of life (Principi et al. 2021). Despite the historical diversity that characterizes Italian territories, the domain mostly contributing to the overall increase in AA levels in each region during the time span of 2007–2018 was employment (Intraligi et al., in press). In light of this territorial inhomogeneity, a more recent policy initiative to overcome the disconnections between policy actors and levels of government operating in this field was created in 2019 at the national level. The “National multi-level co-managed coordination of active aging policies” was based on a three-year agreement (2019–2021) between the National Institute of Health and Science on Aging (INRCA) of Ancona and the Department for Family Policies at the Presidency of the Council of Ministers (DIPOFAM), with the collaboration of both the National Institute for Public Policy Analysis (INAPP) and the Ministry of Labor and Social Policies. The initiative targeted both public and private stakeholders to stimulate, in a coordinated way, the development of policies in the field of AA, defined as follows:

“The ensemble of labor, social, educational and entertaining activities performed by older people (65+ years), among which social participation, education and training, work, culture, tourism, sport, leisure, informal care (e.g., care of older people, grandparenting), social farming and gardening, civic engagement and others”

(Barbabella et al. 2022, p. 6).

An aim of the initiative was to simultaneously address the mentioned three main criticalities linked to the operationalization of the AA concept (Barbabella et al. 2020).

1.3. Aim of This Study

There is a lack of studies concerning the operationalization of the AA concept at the policy level. In particular, there is a lack of knowledge regarding attempts at the policy level to face the three main criticalities identified concerning this operationalization:

• Weak inter-sectoral and multi-level cooperation;
• Scarcity of participatory processes;
• Difficulty in ensuring the multidimensionality of the AA concept.

The present study aims to provide evidence on the latter by exploring Italian regional governments.

This aim gains particular prominence given the increased interest at the national level regarding AA policies. In June 2022, the Italian government hosted the UNECE Ministerial Conference on Aging (20th anniversary of the adoption of the MIPAA/RIS) in Rome, while in the same period, it proposed a national framework law on aging, which includes AA policy measures. This framework was enforced in 2023 (President of the Republic 2023), followed by the first legislative decree No. 29/2024 for its implementation (Official Gazette 2024).

2. Methods

The present study was carried out within the project “National multi-level co-managed coordination of AA policies” (2019–2022).

The project represents an innovative action tool that exploits an Evidence-Based Policy Making (EBPM) approach (Davies and Nutley 2012) to support policymakers in national and regional governments for improving AA policies via coordination, systematization, and engagement of all key actors (Edelenbos 1999).

In 2019, the research team created a wide stakeholder network (including about 100 representatives of as many organizations) involving three main groups of stakeholders3: (a) representatives of national government bodies (Ministries and Departments at the Presidency of the Council of Ministers—PCM) and other relevant national public institutions; (b) representatives of all regional governments; (c) representatives of relevant national civil society organizations, pensioners’ unions, academia, and other stakeholders.

The involvement of groups (a) and (b) allowed us to address the weak inter-sectoral and multi-level cooperation (criticality 1), while the inclusion of group (c) considered the scarcity of participatory processes involving civil society stakeholders (criticality 2). As also argued by Fernandes et al. (2021), the participatory and interactive approach helped in the recognition of different interests and expectations on a policy issue, fostering new solutions through involvement, consultation, and joint discussion of policy options, particularly at the regional level. In order to consider AA in its multidimensionality (criticality 3), the project was based on the UN conceptual framework4 constituted by the 10 MIPAA commitments (UNECE 2002) and the nine SDGs of the Agenda 20305 connected to the MIPAA (Strand 2019). The framework was used to inform the definition of AA adopted in this study, reported in Section 1.2.

Previous project stages concerned the analysis of the state of the art on AA policies in each Italian region (stage 1) (Barbabella et al. 2022), and based on the latter, the production of recommendations for policy development on AA (stage 2) (Lucantoni et al. 2022).

2.1. Fieldwork

By using a topic guide (Outline S1) based on the UN framework described above, which also included, in separate paragraphs, information from the previous two project stages (state of the art and recommendations), semi-structured interviews with managers and officials from regional administrations were conducted in each single region. Participants were recruited through the official contact persons in each region, who were part of the stakeholders’ network of the project. Each official contact person was asked to invite representatives from other departments and services with expertise on AA; the number of participants in each interview varied according to the adhesions collected by the contact persons, although on average, five participants per region were registered (107 in total). Most of them worked in the departments of social policy, health, welfare, agriculture, and labor. The interviews were carried out online between June 2021 and January 2022 and moderated by a member of the research team for an average duration of two hours. The main question asked to the interviewees was to identify “policy objectives in light of the state of the existing art, by applying the recommendations” for each of the AA dimensions included in the UN framework. This specific study concentrates on the dimensions of the framework identified as the three main criticalities linked to the operationalization of the AA concept.

After having collected information from the representatives of regional administrations, the research team produced a first draft report concerning each region, including the results from the perspective of the regional government (Draft-report S2). These draft reports were sent to representatives of the relevant regional civil society organizations (i.e., regional stakeholder networks) (presidents, directors, or their delegates of, e.g., associations of older people, third sector organizations, pensioners’ unions, etc.). The latter were reached by mobilizing regional branches of civil society organizations included in the national stakeholders’ network of the project. The regional stakeholders were asked (through a written contribution): (a) to comment on the perspective of the regional government, and (b) to possibly suggest and motivate “further policy objectives” in addition to those identified by the representatives of regional administrations. On average, 3 representatives of civil society organizations from each region provided feedback (63 in total). This consultation took place via e-mail between July 2021 and January 2022, and this allowed us to also consider the perspective of stakeholders of the civil society.

The results were summarized in 21 reports (one report for each region), published on the project website6, between November 2021 and February 2022.

2.2. Analyses

To analyze the results, a framework analysis was carried out (Ritchie et al. 2018; Weimer and Vining 2017). The analytic structure (

Table 1. Analytic structure of the framework analysis.

N.	Criticalities	UN Framework
1	Weak inter-sectoral and multilevel cooperation	MIPAA 1—Mainstreaming aging
2	Scarcity of participatory processes	SDG 17—Partnership
3	Difficulty in ensuring the multidimensionality of the AA concept	MIPAA 5, SDG 8—Labor market participation MIPAA 6, SDG 4—Lifelong learning MIPAA 9, SDG 16—Caregiving MIPAA 2—Full integration and participation in society: all other domains included in the definition of AA adopted in the project.

) was built by linking the three criticalities highlighted in the literature to the relevant aspects of the AA definition and the UN framework adopted within the project.

A comprehensive review of all primary data (i.e., interviews) (Tonkiss 2004), to identify policy objectives addressing criticalities 1 and 2 in each AA dimension of the UN framework linked to them, namely MIPAA 1 (mainstreaming aging) and SDG17 (partnership), was conducted. Policy objectives addressing criticality 3 have been identified in each AA dimension of the UN framework, consistent with the activities included in the AA definition adopted within the project (Table 1). Subsequently, the data were reduced through a framework matrix (Ritchie et al. 2018) to facilitate systematic comparison and grouping of possible analogous patterns across regions based on the similarity of the policy objectives identified. A data matrix was created in this respect, with the three criticalities comprising the rows and the regions comprising the columns. A summary of relevant information concerning policy objectives was extracted from the 21 reports and was entered into each cell.

3. Results

Three main groups of regions emerged, according to the similarity of the policy objectives identified in relation to the criticalities under study (Figure 1):

• Group 1: regions with policy objectives aimed at refining policies and interventions in the field of AA whose state was advanced.

This group concerned regions that make positive use of a structured regulatory system giving good results in terms of implementation and included Emilia-Romagna, Friuli-Venezia Giulia, Veneto, and Umbria.

• Group 2: regions with policy objectives aimed to better systematize promisingly enforced policies and interventions.

This group encompassed those regions that made use of a good regulatory system that was not yet “fully operational” (e.g., because the laws had only been in force for a short period). This group included Valle d’Aosta, AP of Bolzano, AP of Trento, Liguria, Lazio, Marche, Toscana, Puglia, and Basilicata.

• Group 3: regions with policy objectives aimed to improve AA policies and interventions, which were, in general, quite weak.

This group included, on the one hand, regions that have a promising regulatory framework, but without any particular step being made towards its implementation, and on the other hand, regions with weak AA policies and interventions. It was composed of Lombardia, Piemonte, Abruzzo, Calabria, Campania, Molise, Sardegna, and Sicilia.

In the following, results are provided for the three groups identified. In the tables, the perspective of the representatives of the regional governments is reported. Possible different or additional views of the representatives of the relevant civil society are reported in the text commenting on the tables.

3.1. Weak Inter-Sectoral and Multilevel Cooperation

The results concerning policy objectives aimed at guaranteeing fruitful inter-departmental cooperation on AA issues are summarized in

Table 2. Policy aims concerning mainstreaming aging.

Group 1	Regions
To strengthen the available planning tools (e.g., annual or multi-year strategic plans) in order to consolidate interdepartmental cooperation.	Emilia-Romagna, Friuli-Venezia Giulia, Veneto
To formalize an interdepartmental Permanent Table for AA.	Umbria
Group 2
To establish regional Permanent Tables for AA, or at least to plan regular consultations between regional departments/services.	Valle d’Aosta, Puglia, Basilicata, AP of Bolzano, Lazio, AP of Trento
To include in the Annual Plan for AA interventions from all regional policy sectors by encouraging dialogue between departments and services.	Marche
To strengthen inter-departmental collaborations by giving new impetus to already existing coordination tools (e.g., working groups focused on policies for older people).	Liguria, Toscana
Group 3
To start discussions for creating inter-departmental tables, technical committees, or similar institutional co-decisional tools.	Abruzzo, Molise, Piemonte, Sardegna
Dissemination of AA and related policies among the various regional departments and services so that AA may be recognized as a priority area of policy intervention.	Lombardia
To foster interdepartmental collaboration concerning AA within the activity of already existing co-decisional tools (e.g., the “Table for the Third Age” in Sicilia).	Calabria, Sicilia

.

In group 1, the main objective shared by most of the regions was to consolidate the existing and already effective collaborations through formal co-decisional tools. In the case of Umbria, the latter tool did not exist, so the goal consisted of formalizing the coordination among different regional departments. This was achieved through the creation of an interdepartmental table to provide institutional recognition to the already existing and consolidated dialogue, which was previously realized on a customary basis.

In group 2, the primary finding was the need to promote inter-sectoral cooperation between different regional departments/services through the adoption of adequate coordination (e.g., permanent regional tables on AA, working groups on the subject) and planning tools (e.g., annual plans), which were mostly absent in the regions considered. This excluded Toscana and Liguria, where such tools were present even if not yet fully operational. In the Marche region, a dedicated regional permanent table on AA was formally present; however, its effectiveness in fostering a systematic approach to policies on AA was hampered by a culture more based on sectoral policy development (e.g., the “policy-silos” logic). Therefore, there is the need for extending interdepartmental collaborations within it so that it plays a substantive role in the policy planning and implementation process rather than just an institutional one. In group 3, the need emerged to strengthen sensitivity and political interest on the issue of AA before being able to consider more advanced objectives (e.g., those identified in the other two groups). Exceptions were Sicilia and Calabria, where coordination tools (e.g., Table for the third age) for the development of policies aimed at older people (including not only AA policies) were recently established. Even if these tools are not fully working yet, they still represent preconditions for the achievement of possible policy objectives. Although in Campania, the regional government has not identified objectives on the subject of AA, the stakeholders of civil society have proposed, as a policy goal, the approval of a regional observatory on AA, which should include all regional departments.

3.2. Scarcity of Participatory Processes

Policy objectives aimed at guaranteeing the involvement of all key stakeholders in policy-making processes concerning AA are reported in

Table 3. Policy aims concerning stakeholder participation.

Group 1	Regions
Consolidation/strengthening of the stakeholder networks that are present in already existing co-decisional tools.	Emilia-Romagna, Friuli-Venezia Giulia, Umbria, Veneto
Progressive development of collaborative innovation by setting up stakeholder networks linked to science, policy, industry, and civil society sectors.	Friuli-Venezia Giulia
Group 2
To foresee, through the creation of governance tools or the approval/implementation of regional laws, the establishment of networks that include all relevant stakeholders of the civil society.	Puglia, Basilicata, AP of Bolzano, Lazio, and Toscana
To discuss AA issues with stakeholder networks of already existing regional tables that are focused on other topics regarding older age (e.g., the table for culture and craftsmanship).	Valle d’Aosta
To consolidate the existing collaborations by financing interventions and projects to be built in partnership among stakeholders.	Liguria, Marche
To consolidate partnerships by developing a digital platform for sharing information and networking.	AP of Trento
Group 3
To develop a register/list of stakeholders to be involved in the creation of a network.	Abruzzo, Lombardia, Molise, Piemonte, Sicilia
To use the existing initiatives/co-decisional tools to promote dialogue between public and private sectors (e.g., the “Consult of local authorities and the Consult of third sector”).	Calabria, Sardegna

.

In order to involve actors and interests as heterogeneously as possible, it was proposed, in group 1, to create a broader system of partnerships composed of various stakeholders networks working on different aspects of AA (e.g., a stakeholders network dealing with labor market issues, another focused on creating opportunities for lifelong learning, and both coordinating with each other to form a system) (Friuli-Venezia Giulia).

Some of the objectives identified by group 2 were partially in line with those identified in the first one; for example, to develop collaborations with civil society stakeholders by creating networks through regional laws on AA and/or coordination tools (e.g., tables, observatories). However, unlike group 1, such tools have yet to be approved or implemented, with the exception of Marche, where dedicated co-decisional tools were already established and implemented. Also, it was proposed to consolidate partnerships by creating a digital platform and to connect stakeholder networks from other existing tables concerning older people. In other cases, a less systemic and more operational vision was identified as a policy objective (e.g., Liguria), which was also shared by some regions from group 3 (Table 3).

The latter group differed more from the other ones, as there was a need to start by identifying potential stakeholders to be involved in the future creation of networks. This implies the need for a greater effort by these regions to bridge the existing gap in the subject. Also, in this case, Campania had not identified policy objectives, while civil society stakeholders asked for greater involvement of them in the policy-making process on AA.

3.3. Difficulty in Ensuring the Multidimensionality of the AA Concept

The results concerning policy objectives identified by the regions to ensure the widening of the existing AA opportunities are reported in

Table 4. Policy aims concerning participation of older persons in society.

Group 1	Regions
To digitalize the regional cultural heritage for the benefit of older people with lower independence.	Emilia-Romagna, Friuli-Venezia Giulia, Veneto
To encourage knowledge transfer from older to younger workers (and vice versa) and to promote the gradual exit from the labor market (e.g., generational relay).	Emilia-Romagna, Umbria
To create a “Universities of the Third Age (U3A) Assembly”.	Emilia-Romagna, Friuli-Venezia Giulia, Veneto
To support carers by creating a dedicated platform and tools to combat carers’ stress.	Emilia-Romagna, Friuli-Venezia Giulia
Group 2
To adopt/implement a regional law to provide increasing opportunities for AA in a multidimensional way.	Valle d’Aosta, Puglia, Basilicata, AP of Bolzano, Lazio, Marche, Toscana
To create places such as clubs/centers for older people, etc.	Lazio
To promote training activities and the exchange of knowledge between older and younger workers, favoring generational turnover.	Valle d’Aosta, Basilicata, AP of Bolzano, Marche, AP of Trento
Adoption of flexible working methods and provision of diagnostic and prevention tools to ensure the health and well-being of older workers.	Puglia, Liguria
To promote collaboration between the U3A, schools of all levels, universities, and museums by also creating “Third age forums” for discussion and training.	Basilicata, AP of Bolzano, Lazio, Liguria, AP of Trento
To develop training, relief activities, and digital platforms to support older carers.	Valle d’Aosta, Basilicata
To map the care burden and to establish a list/registry of carers.	Basilicata, Lazio, Marche
Group 3
To approve/implement dedicated regional laws for providing AA opportunities in a multidimensional way.	Abruzzo, Calabria, Lombardia, Molise, Sicilia
To develop initiatives for intergenerational knowledge transfer, training and retraining courses for unemployed older people, and work–family reconciliation.	Abruzzo, Calabria, Lombardia, Molise, Piemonte, Sardegna, Sicilia
To guarantee a widespread diffusion of the U3A by formalizing their collaboration with social/aggregation centers.	Calabria, Molise
To strengthen the link between lifelong learning initiatives and opportunities to access the labor market.	Abruzzo
To activate computer literacy courses for older people.	Sardegna
To establish a register for carers and older people in need of care.	Abruzzo, Campania, Molise, Sardegna
To approve a regional law on care in which the rights of the informal carers are recognized.	Sicilia

.

With reference to the multidimensionality of AA, it has to be considered that regions included in group 1 could use already existing and effective laws and co-decisional or planning tools with specific aims (e.g., related to strengthening initiatives in the AA domain of culture), while in the other two groups of regions, the policy aim of enacting such laws was quite recurrent. More about group 1, a frequent aim—mentioned by representatives of the civil society and not reported in Table 4—concerned the urge to adopt a national framework law for the promotion of AA that embeds the progress of regional policies on this topic within a broader, nationwide process. This ensures the financial coverage of the regional initiatives for increasing participation and integration of older people in the medium to long term.

Beyond the general participation and integration of older people in society (MIPAA 2), we also stressed the specific AA domains of labor market participation (MIPAA 5, SDG 8), lifelong learning (MIPAA 6, SDG 4), and care (MIPAA 9, SDG 16).

We found specific policy aims for each of these domains.

Regarding the labor market domain, policy aims were focused on promoting age management measures, which appeared to be underdeveloped in all groups of regions, thus resulting in the identification of similar objectives across groups.

As for the domain of lifelong learning, in most of the regions included in group 1, it was decided to strengthen the coordination with U3As and to provide more support to them. In the other two groups, all the regions identified, as a first step, opportunities for starting collaborations with the various organizations dealing with lifelong learning in each territory.

As far as the domain of care is concerned, the specific objectives identified (the dedicated digital platform and the management of carers’ stress) will be developed in the context of existing specific regulations on this aspect (i.e., regional laws on carers’ rights). The aims of the regions included in groups 2 and 3 represented the first step towards the future development of AA initiatives in this domain.

4. Discussion

In light of the effectiveness of AA as a prevention tool and of the lack of knowledge regarding policy efforts to face the main existing criticalities in relation to the operationalization of the AA concept, the present study was aimed at understanding whether and to what extent Italian regional governments planned to implement intersectoral and multilevel cooperation in a mainstreaming aging perspective participatory processes by involving the relevant stakeholders in policymaking, as well as the multidimensionality of AA. The purpose was to instrumentally link the criticalities of policy tools (Jann and Wegrich 2007) for designing policy innovation that embraces complexity and is proactive, focusing on citizens, shaping new alliances, and facilitating stewardship (Flick 2005) in order to improve the application at the policy level of this useful prevention tool. The three criticalities were studied in terms of specific and concrete policy objectives identified by exploring both the perspective of regional governments and the one of the relevant regional civil societies. It was found that such policy aims are in place in all Italian regions, but with differences between them. The results pointed out that criticalities are more or less pronounced across territories; therefore, policy aims are different across regions, mainly depending on two factors: the presence of a relevant regulatory framework and its degree of implementation. In general, even with some exceptions, in regions where both legislation and its implementation were at an advanced state, the three criticalities have been addressed to a considerable extent; in the case of an existing legislative framework with a weak degree of implementation, the three criticalities were addressed to a lesser extent; while in case of weak or absent legislation, they were addressed even less. However, policy objectives concerning the three main policy criticalities linked to the operationalization of the concept were found and recognized in all regions.

Concerning the policy aims identified to address the critical aspect of multi-sectoral and multi-level collaboration (mainstreaming aging), the experience of the Umbria region demonstrated that, in principle, it might be possible to properly deal with this criticality without establishing a formal tool, thanks to a strong political commitment and adequate resources (Barbabella et al. 2022), which are decisive factors in any political field (Crepaz et al. 2021; Post et al. 2010). However, the new aim identified in this region of formally establishing an inter-departmental table dedicated to AA policies was considered as an improvement in this situation. Indeed, as political commitment and resources may not be guaranteed at the same levels in time (Breunig and Koski 2018), the formal presence of governance coordination tools will ensure adequate coverage of AA issues over time (Barbosa et al. 2016). Such coordination tools would also facilitate the dialogue between public administrations and civil society stakeholders, which is internationally weak in several cases (Barbosa et al. 2016; Cejudo and Michel 2017; Fernandes et al. 2021).

Concerning the criticality of improving co-decisional policymaking by involving stakeholders of civil society, it was much more pronounced in regions without a regulatory AA framework. Policy objectives in that respect identified in these regions were configured as preparatory actions for developing a stakeholders’ network. In some regional contexts (e.g., Molise and Lombardia), the main obstacle to stakeholders’ involvement may be, in addition to the absence of regulatory tools, a missing internal (within the public administration) shared culture on AA (Barbabella et al. 2022), which is essential when AA needs to stay high on the political agenda (Brüchert et al. 2021). In these contexts, the implementation of awareness-raising actions and training sessions for public officials and managers may be helpful, since they have proven to be useful tools from a shared-culture perspective (Liboro 2015). A further topic that emerged in this group of regions is the well-known tendency of public administrations to take policy decisions unilaterally, without considering the perspectives of other relevant stakeholders (Stenner et al. 2011). I-This is the case oinCampania, where no policy objectives in this respect were set by the representatives of the regional administration. However, this topic was found to be very important to the regional civil society stakeholders, who suggest that to overcome this problem, the establishment of national laws with binding provisions for regional governments concerning participatory policy processes may be useful. This policy mechanism of central governments guiding the policymaking of regional governments has also proved to be effective in other countries, independent from the policy area addressed (Aleksandrowicz 2005).

Regarding the policy operationalization of the multidimensionality of AA, it has to be considered that, as in most other countries (Lassen and Moreira 2014), contrary to all other AA domains, the specific domain of employment in Italy is mainly regulated at the national level, so that room for maneuvering is limited for regional governments in this area. One possible action by regions concerns promotion of policies for companies in the field of employees’ age management, and a few of the regions started planning specific initiatives in this respect. This would allow them to systematically deal with an unexplored field of actions in Italy, both in terms of public and company (Human Resource Management) policies (Principi et al. 2015, 2020), contrary to what happens in other countries (Scoppetta and Aparicio Jodar 2019). The general absence of regional policies to promote companies’ age management of employees may still be due to the distribution of competing responsibilities between the central government and regional governments on the subject of the labor market (Contini and Rapiti 1999).

As for AA domains other than employment, the results indicated that civil society stakeholders, except for a few cases, recognized the difficulties of regional governments in guaranteeing multidimensionality. Indeed, to overcome the regional governmental level, their call for more resources through a national law devoted to AA—which could feed the regional policy level—was high. Considering that about 66 percent of Italian regions have enforced their own law on the promotion of AA, and that 57 percent have adopted a formal governance body (e.g., regional tables, councils) to coordinate and implement AA regional policies and laws through a participatory process (most of them in the last about five years), this may sound surprising. However, economic resources allocated by regions to guarantee AA multidimensionality are, in the majority of cases, largely insufficient, which seems to be an issue not only in Italy (São José et al. 2017). Exceptions to this are the regions we included in group 1. For example, the Veneto region has allocated 1 million euros per year (drawing from both the Regional Health Fund and the National Social Policies Fund) to develop AA initiatives since the approval of the regional law on AA (LR 23/2017). Likewise, in the period of 2012–2020, the Umbria Region, drawing on various funds (e.g., regional social fund, national health fund, community funds of the European Social Fund), has allocated a cumulative sum of 1 million and 250 thousand euros to finance policies on AA, while Friuli-Venezia Giulia has earmarked about 500 thousand euros per year (Barbabella et al. 2022). As for the regions included in groups 2 and 3, apart from the case of Piemonte, where about 1 million euros have recently been allocated for the development of policies dedicated to AA, allocated resources have been absent or inconsistent over time (Barbabella et al. 2022). In this respect, a step forward could be moved in the (relatively short) term, since in March 2023, the national government enforced law no. 33/2023, “Provisions to the Government on Policies for Older People”, and in March 2024, the first legislative decree, no. 29/2024, “Provisions on Policies in favor of the Older People”, for its implementation. The latter, for the first time in Italy, will regulate AA (Art. 3) at the national level, and this would make it possible to systematically consider and develop policy objectives identified in every AA domain. In the future, it is expected that the national law will provide the opportunity to systematically deal with the main differences and criticalities related to the AA operationalization at the regional policy level, with positive long-term effects on sustaining and enhancing physical and mental health and preventing multimorbidity in later life (Foster and Walker 2021; Zelenev 2006). This might be accomplished through the coordination and guidance provided by the “Interministerial Committee on Policies for the Older Person (CIPA)” (Art. 2), which will be responsible for adopting the “National Plan for Active Aging, Social Inclusion, and Prevention of Frailty in the Older Population” every three years. According to the legislative decree no. 29/2024, the three-year plan on AA will be developed and updated yearly by the CIPA on the basis of annual reports to be produced by the regions, including all the AA policies and initiatives carried out during each year, as well as those to be developed in the future, according to the policy goals set (art. 6, paragraph 3).

Based on the analysis of the results, some interesting evidence also emerged regarding the geographical distribution of the regions. Mainly northern regions (with the exception of Umbria) set policy objectives aimed at refining policies and interventions in the field of AA, which was advanced. Instead, aims of greater systematization of promisingly enforced or weak policies and interventions were mostly set by southern and central regions. While at the time of the fieldwork, the northern Piedmont region was included in the latter group of regions, it later implemented a Regional Law on the promotion of AA by guaranteeing the provision of adequate economic resources (Piemonte Region 2019). The geographical snapshot suggests that even though the “classic” tri-partition (north–central–south) (Musolino 2018) is broadly visible, this divide does not fully reverberate on the capacity to create effective policies in the case of AA. In this sense, it is assumed that cultural, traditional, and path-dependence reasons (Ney 2005) that go beyond geographical distinctions may affect the paradigm shift required by the adoption of the AA concept. In line with this, there are differences across Italian regions in terms of “fastness” in incorporating the AA paradigm within their policy agendas for benefiting both older individuals and the regional community (Zannella et al. 2021). In this respect, the opportunities provided by the mentioned law no. 33/2023 and the legislative decree no. 29/2024 may concern not only the proper operationalization of the AA concept but also a progressive harmonization and coordination of the policies to overcome territorial disparities.

Limitations and Future Research

Although the present study advances the knowledge in this unexplored field, its results need to be complemented by (and compared to) the results of other similar national experiences so that these experiences may build upon and improve each other. Thus, future research should focus on this. Indeed, dilemmas and solutions that are based on a specific national or regional context can be highly relevant to policymakers across Europe (Barland et al. 2016). Focusing on Italy, the policy objectives identified have the limitation of not being binding, leaving their actual implementation to the discretion of each regional government. In this regard, future research should focus on the impact of the recently enforced law no. 33/2023, and in particular, the legislative decree no. 29/2024. As these regulations were enforced after the conduction of this study, it should be tested whether the new regulatory framework will be helpful to allow regional governments to fulfill the policy aims they identified here.

Limitations usually associated with studies adopting qualitative research methods, including the present one, are the extent to which they cover issues linked to the results, such as transferability, confirmability, credibility, and dependability (Lincoln and Guba 1985). Although it is challenging to guarantee these qualities are ensured, we did our best to manage them properly. For instance, we used clear and replicable topic guides for the interviews based on previous multi-year studies on AA policies in Italy (Barbabella et al. 2022), peer debriefing sessions among expert researchers (e.g., to define logistics and topic guides), and feedback exchanges with the involved stakeholders in order to discuss initial findings. We also carefully considered the aspect of the rigorous description of the research steps taken from the start of the research to the development and the final reporting of the findings (Korstjens and Moser 2018), this favoring the replicability of this study in other contexts.